Osawa Ryosuke, Asai Takashi, Okuda Yasuhisa
Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, Koshigaya, Saitama, Japan.
Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Minami-Koshigaya, Koshigaya, Saitama, Japan.
Br J Anaesth. 2024 Oct 24. doi: 10.1016/j.bja.2024.08.036.
Flexible bronchoscopy for tracheal intubation is indicated in patients with difficult airways, but the upper airway is frequently obstructed in sedated or anaesthetised apnoeic patients. This makes it more difficult to locate the glottis through bronchoscopy, and increases the risk of hypoxaemia. Nasal high-flow oxygenation is useful to prevent hypoxaemia during airway management, but no studies have assessed if this method of oxygenation improves the bronchoscopic view of the glottis by preventing upper airway obstruction.
As a crossover design, we studied 20 anaesthetised apnoeic patients to assess if nasal high-flow oxygenation (60 L min) improves the view of the glottis during attempts at bronchoscopic intubation by widening the pharyngeal space.
The pharyngeal space was wider with nasal high-flow oxygenation than without in 19 of 20 patients (95%; 95% confidence interval [CI]: 85-100%; P<0.0001), and bronchoscopic view of the glottis was better with high-flow oxygenation than without in 17 of 20 patients (85%; 95% CI: 69-100%, P<0.0001). The flexible bronchoscope was easily inserted into the trachea in all patients, and no complications including hypoxaemia were observed.
Nasal high-flow oxygenation facilitates flexible bronchoscopy for tracheal intubation by widening the pharyngeal space and by improving the view of the glottis through the bronchoscope. Therefore, use of nasal high-flow oxygenation is useful in patients with difficult airways in whom flexible bronchoscopy for tracheal intubation is indicated.
对于气道困难的患者，可采用可弯曲支气管镜进行气管插管，但在使用镇静剂或麻醉剂的呼吸暂停患者中，上呼吸道常出现梗阻。这使得通过支气管镜定位声门更加困难，并增加了低氧血症的风险。经鼻高流量给氧有助于在气道管理过程中预防低氧血症，但尚无研究评估这种给氧方法是否能通过防止上呼吸道梗阻来改善支气管镜下声门的视野。
作为交叉设计，我们研究了20例麻醉后呼吸暂停的患者，以评估经鼻高流量给氧（60 L/min）是否通过扩大咽腔空间来改善支气管镜插管时声门的视野。
20例患者中有19例（95%；95%置信区间[CI]：85 - 100%；P<0.0001）经鼻高流量给氧时的咽腔空间比未给氧时更宽，20例患者中有17例（85%；95% CI：69 - 100%，P<0.0001）经高流量给氧时支气管镜下声门的视野比未给氧时更好。所有患者的可弯曲支气管镜均易于插入气管，未观察到包括低氧血症在内的并发症。
经鼻高流量给氧通过扩大咽腔空间并改善支气管镜下声门的视野，便于进行可弯曲支气管镜引导的气管插管。因此，对于需要进行可弯曲支气管镜引导气管插管的气道困难患者，使用经鼻高流量给氧是有益的。
